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FOR OFFICE USE: �6. 3APPLICATION FOR SANITATION PERMIT -- -- F...- - ----•• • PermitNo. 7-..��13. (Complete In Triplicate) .......... ....,.........__..........--•--.............._ ................. This Permit Expires f Year from Date Issued Date Issued . .................. Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC�AT^I—O�N ....- .. .... �rG tea/ 77'�._. �fiw .....CENSUS TRACT .......................... Owner's Name ............. ............. Phone .....F... ......................._.. AddressCity . . .moi �cJ�. K, Contractor's Name -L �Fle/.!6 .....................License # ��5X./; 3.. Phone Installation will serve: Residence Q Apartment House Commercial QTrailer Court Motel ❑Other ............................................ Number of living units;------------ Number of bedrooms ------------Garbage Grinder ............ Lot Size 'e��2' .1 ?, €..�.�. Water Supply: Public System and name ...---.......................................... .......----•................................................Private Q Character of soil to a depth of 3 feet: Sand Q Silt❑ Gay Q Peat Q Sandy Loam Q Clay Loam ❑ Hardpan[] Adobe❑ Fill Material --- ........ If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 31de.I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK[ ] SizeXIVI ................................................ L€quid Depth .......................... �.X i.5ia5Ca acstY --------- ---------- Type •................. .Material---•---•----•- No. Compartments Distance to nearest: Well ........... ........................Foundation ...................... Prop. Line .................. LEACHING LINENo. of Lines ] ----•-- -.--------------- Length of each line .......... Total Length ......... 'D' Box -._ Type Filter Material Depth Filter Material .... .............................. Distance to nearest: Well ---j§V--------- Foundation ...ZA!.J............. Property Line _. ... .... SEEPAGE PIT [ J Depth --za-5—j------ Diameter ...0-- -- Number __..._._�.___...__/ Rock Filled Yes 91--"'No 0 c Water Table Depth _.__.�Z..�---------------`•-•----•---------Rock Size Distance to nearest: Well ......�I.�...................Foundation .-fes_........_. Prop. Line ..: ....---....._. REPAIR/ADDITION(Prev. Sanitation Permit# _.-..-----------------------------•.---..._. Dote ....................................I Septic Tank (Specify Requirements) ................. Disp sal F€eld (Specify Requirements) ---- ....__.s S..__X_f.S------. - w �✓.... `? �................ --- —-----/..... 9-7---` X- r ' �� --c.2t� ,. - .................. -fix�s_Tifrf ----------- ----- -- -•-----------------------.._---------.. fDr existing and required addition on reverse side( I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Distdct. Horne owner or licen- sed agents signature certifies the following: "i certify that In the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become pdViect 19 Wo[kman's Com nsation laws of California." Signed r = Owner BY ----- --------------------- --------- - - - ----- -----•-••----------.------._.. Title ........ ---•-- ............... (If. ther t owners FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y __.... ........------:.. --------------------------------- ............... DATE .... ..7�.Y ------------ BUILDING PERMIT ISSUE 7 �� _............. D TE - -- ._.._._------.._._..--------- ADDITIONAL COMMENT "�� l� � •. - ----------•-•--------------------------•--- ----------••-•-------• -••-------•-•----•--•--•-•-.... . ••---------------•---------•--- .._..........._. ._._......_........__...... -----------•-•---------------------•---- •-- .-. .. _--- ----• ------- .._. ---------------- -••-----••--•---••-----------........ ........................._._. FinalInspection by: ------------•- - • ------ --------- --------------- --------- -------------...._.---._._..--- -------.Date .... ---_... ... ........... EH 3 2!t 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8711 3M